S02_E19 - Feeling the Burn. Talking Upper GI Health with Dr. Jake Matlock.

Speaker 1: 0:00

<silence>

Speaker 2: 0:04

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, healthcare and what matters to you. And now here's our host, Dr. David Hilden .

Speaker 3: 0:21

Hi everybody. It's Dr. David Hilden, your host of the Healthy Matters podcast. Welcome to episode 19 where we are going to explore your upper GI tract. You ask what that is? Well , we're gonna find out. So it's a holiday weekend and hopefully you're getting together with family and friends, or you're enjoying the unofficial last few days of summer. Many of those holiday gatherings revolve around the grill and food that we all enjoy. However, for some of us, these foods bring on heartburn, gastric reflux. Maybe some of us can't even enjoy our favorite foods 'cause we're suffering from ulcers. On today's episode of the podcast, I am joined once again by gastroenterologist, Dr. Jake Matlock, who is gonna help us understand what all these ailments are, what causes them, and the best ways to prevent them. Thanks for being back on the show, Dr. Matlock.

Speaker 4: 1:07

Glad to be here, David.

Speaker 3: 1:08

Okay, Jake, let's start talking about sort of the basics. What causes upset stomach or indigestion?

Speaker 4: 1:16

Well, the short answer, David, is that there's not one cause. As with many , uh, symptoms that people have, there are a number of things that can cause you to have an upset stomach. Some of them are predictable and transient. Uh , I think all of us know that there's certain foods that don't agree with us. And, and, you know, maybe we like those foods and we choose to eat them sometimes and decide that, hey, you know, it's worth it today to have that hamburger or to have that , uh, uh, chili pepper. Uh, others , uh, uh, are more persistent and not necessarily related to the foods that we eat. And, and that's, that's when things start to get more concerning and potentially more serious.

Speaker 3: 1:52

So some of it could be what we eat, but not all of it. So with that gas station sushi I had the other day, was that, was that a good idea?

Speaker 4: 1:59

Yeah. And then , and you may know that for you gas station sushi is gonna upset your stomach and you may decide today that's worth it for me. 'cause I really want that gas station sushi. Mm-hmm. <affirmative> . Uh, and that's okay. Uh, you know, once you know that about yourself , uh, it may not be a good idea to do it all the time, but on an occasion, you know, a dietary indiscretion that you pay for for , uh, an hour or so afterwards is not the end of the world.

Speaker 3: 2:24

I wanna delve into that. Um, and you use the term that I use all the time. It's the doctor term dietary indiscretion is, is the doctor term for what we always say that for . You probably shouldn't eaten that, but <laugh> , you're gonna live with the consequences. There is a local , uh, Mexican American restaurant in Delta , Minneapolis that I've been going to for 40 years, and I'm not gonna name it , um, but it has the best salsa in the world. Every time I eat this salsa I have this. And I I've even said to myself, it was worth it. Yeah. So what is happening to your stomach when you eat, say, a really spicy food? Uh, uh, what is happening in , uh, physiologically in your body?

Speaker 4: 3:02

So your stomach's a pretty hostile environment in general. And , uh, you know, it's, it's basically a big bag of muscle that is full of an acidic soup. And, and its job is to take the food that you eat, whatever you decide to put into it, break it down with acid, and then using the muscle , uh, of the stomach wall to mix and grind and break those particles of food into smaller particles that can then be transmitted down further into your digestive tract. Once you get down further, that acid gets neutralized and, and the magic of absorption happens. But in that hostile environment of the stomach, if you're adding in more things that make the environment more acidic or more caustic, then the normal protective lining of the stomach may not be enough to, to fully protect you from symptoms. Now, whether those symptoms signal something that's actually causing damage is a whole nother question entirely. But that's what you're feeling. Uh , when , when you get that heartburn, indigestion, acid reflux, upset stomach. So

Speaker 3: 4:06

Your stomach, why doesn't it get damaged permanently by all this acid in there? Why doesn't like self digest itself?

Speaker 4: 4:13

So your stomach lining secretes a , a mucus , uh, that coats the lining and protects it from its own acid. And there are things , uh, that can break down that mucus lining and break down that protective barrier. Certain medications can do it , uh, an infection with a , an organism called h pylori can do it. Uh , but in general, your stomach is able to coat its own lining and protect itself from itself.

Speaker 3: 4:39

So let's talk about that. The word heartburn Yeah. Um, that people sometimes get. Is that what we're talking about here? Or is that a distinct separate thing? And why do we call it that

Speaker 4: 4:48

<laugh> ? So, so that is, at least from a medical perspective, a separate thing. It's often hard to distinguish , uh, when you're, when you're talking to somebody about symptoms. 'cause you know, often , uh, what we are experiencing as a person when we're having these symptoms is pain. That's somewhere from right underneath our breast bone radiating up to somewhere between our, our collarbones. And, you know exactly where it is and exactly how long it lasts and whether it moves around. It helps us as clinicians to, to give it a label. I'm not certain that those labels are that meaningful. Mm-hmm . <affirmative> , you know, it , it hurts. Uh, and , and that's really what matters. And it's, and most of the symptoms are felt to be, at least to some degree, related to the acid in the stomach. When we talk about heartburn, classically what we're talking about is, is pain related to the movement of contents from your stomach up into your esophagus or swallowing tube. That, that tube that runs through your chest from your mouth down to your stomach. So

Speaker 3: 5:48

Reflux.

Speaker 4: 5:49

Yeah. Well , usually yes. Yeah . And, and , and that, that structure, your swallowing tube, your esophagus doesn't have the same kind of protective mucus coating that your stomach does. It's, it's not well suited to be acid resistant. So when it's exposed to the contents of your stomach, it hurts.

Speaker 3: 6:07

Right? So we're gonna delve into acid reflux as a specific entity in just a few minutes. But before we do, there's all kinds of things you can buy at the store. Plop, plop, fizz . Fizz .

Speaker 4: 6:18

Yeah . Soer . What a relief. Well ,

Speaker 3: 6:20

What a relief it is. Many of us remember that commercial not to like , uh, tell one particular product, but there's that, there's Pepto Bismol, there's all these other things, and we're gonna get into some of them more as the show wears on. But just lay the , the groundwork for us on those remedies. Are they helpful?

Speaker 4: 6:36

So they are helpful and, and choosing amongst them and when it's appropriate to use one versus the other is the tricky part. And, and, you know, the marketing that , uh, goes along with it doesn't, doesn't make that choice any easier for people. I think , uh, what all of the medicines do, and, and here I'm talking about Tums , ALCA , seltzer, Malo , uh, Pepcid , Prilosec , omeprazole, all of these things are medications that are intended to change the balance of the acidity in whatever is in your stomach. None of them change the fact that things reflux up into your esophagus. They don't alter that at all. They just change what's in the soup. What's important to understand about the drugs is how much they can change what's in the soup and how quickly they can change it. So something like Alca Seltzer or Toms or Rolaids , those are products that are buffering agents. They can rapidly change an acid into a less acidic mixture. So they work quickly. So if you've

Speaker 3: 7:39

Got within

Speaker 4: 7:39

Minutes. Minutes, yeah. Yeah . So if you want, if you want relief right now, that's where you should go. If you've got some time, if you, you know, can wait 15 minutes, 30 minutes, an hour, you might want to go with a medication like Pepcid or Ranitidine. These are medications that have also been around for a long time. They also reduce the acidity , uh, of your stomach secretions, but they take longer to work. And then the , the most popular and and probably most potent drugs that we have are, are a class of drugs called proton pump inhibitors. And omeprazole or Prilosec, the most common of those, those are the most effective at reducing the acid content of your stomach. But they take a long time to work. Typically, they reach maximal effect after a period of a few days of exposure. And so if you want relief right now, pop in a PRIs X , probably not your most effective , uh, move.

Speaker 3: 8:33

That's a good time for me to pivot then to gerd, gastroesophageal Reflux Disease. Many people experience this, you've touched on it already, but tell us a little bit what is happening in acid reflux disease?

Speaker 4: 8:47

All of us have a barrier between our esophagus or swallowing tube and our stomach. And that barrier is very smart, but imperfect.

Speaker 3: 8:56

Hey, I think mine's perfect. Yours

Speaker 4: 8:57

Is perfect. Everybody else's is smart, but imperfect <laugh> , uh, what I mean by that is it's, it's smart in that it has, this barrier has to open when you swallow food to allow food to get into your stomach. Mm-hmm . <affirmative> . And then it has to know when to open and, and then rapidly close after the food passes. What I mean by imperfect is that nobody's barrier completely prevents contents of the stomach from moving up into the esophagus. All of us have that happen to some degree with some frequency. Some of us, particularly if the contents of our stomach are particularly acidic or caustic, will feel that when it happens. Now, when that happens, our esophagus responds by, by squeezing and, and pushing things back down into the stomach. And, and that squeezing and pushing function can become impaired. So we may not do that as well as we did when we were 18. And some of us have a more imperfect valve. And so we get more frequent episodes of stuff washing back up into our esophagus. And if it's enough to bother us enough to bring us to the attention of a healthcare professional, we, we may get labeled as having GERD or reflux disease. Um , but it's, it's really a problem of, of quality, not quantity necessarily.

Speaker 3: 10:10

So how do you know if it's serious, if, if, if some of us every now and then get a little upset tummy, a little indigestion and a little heartburn, but it happens really rarely. Maybe it's not so serious, however, it can be. Right? How do you know when it's serious? There

Speaker 4: 10:24

Are certain alarm features that we look for, that signal the need to look into it a little more deeply. So as you said, if you get a little bit of heartburn every once in a while, you know, it passes with some time. Or maybe by drinking something that's non acidic like some milk. Or you take a tums and it goes away and then you don't think about it for several weeks until you have, you know, more of that gas station sushi perhaps. Then it's probably nothing to worry about. We do start to get worried if it's persistent, it's happening more than once a week. It's happening really without an identifiable trigger. If you've lived your whole life and it's never happened to you before, and now all of a sudden it's happening all the time, if it's a significant change for you , that's concerning. And then other things which are a little bit more obvious, you know, if you're throwing up blood or if you are, you know, losing 20 pounds without trying to, or if food's getting stuck and is not going down , uh, and you're not able to get food to your stomach, those are things that would bring most people to the doctor. But if, if not, that's, that would be recommended. Okay.

Speaker 3: 11:27

So what happens in chronic acid reflux disease if you don't treat it?

Speaker 4: 11:32

So it, it depends on how frequently it's occurring and how much acid the esophagus is being exposed to. Uh, some people can have occasional heartburn or , or acid reflux for their entire lives, decide they're just gonna live with it and do fine. That doesn't make me happy. There are things we can do to make people feel better that, that, that I wish that they would let us help 'em with. But it's not necessarily something that shortens your life or ends your life or leads to problems. The concern, though, is that for some people, it, it does do those things. And so if you have persistent acid exposure and it is a, a, a problem that is causing you symptoms on a frequent basis, getting it evaluated is probably a good idea. And the things that we would be worried about would be burns to the esophagus from acid scarring from repeated cycles of burns and healing and burns and healing the creation of strictures or narrowings from scar tissue build up in the esophagus. And even occasionally the development of, of cancers of the esophagus from chronic inflammation. Now, and I don't wanna be alarmist, those cancers are not terribly common, but they do occur And, and talking to a healthcare professional about your symptoms and trying to figure out do they merit further evaluation is probably important if you're, if they're continuing to bother you. We're gonna

Speaker 3: 12:46

Talk about how you do diagnose these things and about what's an endoscopy and all that after the break. Before we do that, one last question about treatments. People take medications ongoing for a long period of time and they can get relief of their symptoms. Is there any problem with doing that, taking medications for the long term ?

Speaker 4: 13:05

So I think the important thing if you're gonna be taking a medication for the long term is understanding what it is that you're doing, why you're taking it. And with medications for upper digestive problems, there are two separate reasons to be on them. One is to make you feel better, to make the symptoms go away, and that's fine. The other is to try to protect you from some future bad thing, some bad healthcare consequence of not being on the medicine. Those goals are not always aligned with one another. So some people have conditions of their upper digestive tract, and I'll tell 'em, you know, you need to take this pill every day to protect yourself from something bad in the future. And they'll say to me, you know, I don't feel any better or worse if I take this. And so it's important for me to be able to clarify with them that I get it. I know this doesn't make a difference how you feel. I'm trying to protect you from the bad thing in the future. Others, again, Prilosec is a good example. I got plenty of patients who take a Prilosec every day to prevent or lessen the severity of their heartburn. If they miss a couple of days, they pay for it. You know, maybe I've looked in their stomach, maybe I haven't. And, and I know that they don't have any damage down there. They're not at risk for anything in the future, but it's okay for them to continue to take that 'cause it does make 'em feel better. So I think really clarifying what it is that you're shooting for and understanding what the goals of that therapy are is important in determining whether or not you should stay on it.

Speaker 3: 14:25

We're talking with Jake Matlock. He is the division director of Gastroenterology here at Hennepin Healthcare . And we've been talking about disorders of your stomach and esophagus. When we come back, we're gonna talk about ulcers, endoscopies, and Jake's best tips for staying healthy. Stay with us. We'll be right back.

Speaker 2: 14:43

You are listening to the Healthy Matters podcast with Dr. David Hilden . Got a question or comment for the doc, email us at Healthy matters@hcme.org or give us a call at six one two eight seven three talk. That's 6 1 2 8 7 3 8 2 5 5. And now let's get back to more healthy conversation.

Speaker 3: 15:06

And we're back talking about your upper GI tract with Dr. Jake Matlock. Jake, what's a gastric ulcer?

Speaker 4: 15:13

So as we were talking about earlier, the stomach has a mucus lining that protects it from its own acid, and sometimes that mucus can break down. And if that happens, then the tissue underneath the mucus gets exposed to the acid and that tissue then becomes injured. That injury impairs the ability of the stomach lining to make more mucus. And so it becomes kind of a self-perpetuating cycle of inflammation, injury and damage. And over time, the acid will then eat away and create a divot in the lining of the stomach. So an ulcer is really like a divot or a chunk that's taken out of the lining, exposing what's underneath the lining, which is muscles and blood vessels and, and the like. That number one can be very painful. Uh, so many patients who have ulcers will, will suffer a lot of, of pain and and misery from them . And number two can lead to worse problems like bleeding from ulcers , uh, because the blood

Speaker 3: 16:11

Vessels get

Speaker 4: 16:11

Exposed because the blood vessels get exposed and they're not acid resistant. Yeah . So they , they will open up and bleed, or even if it's very severe , uh, can wear a hole entirely through the stomach and create what's called a , a perforation, which is a surgical emergency. So really bad that can be very

Speaker 3: 16:27

Serious. How does someone know they might have an ulcer? What would be the symptoms?

Speaker 4: 16:31

So classically we think of ulcers as causing pain in the upper part of your , uh, abdomen or stomach. So somewhere underneath your rib cage. And that pain is classically described as worse when your stomach is empty and better when you put certain things into it. Most notably, things that are not acidic. People who , uh, have kind of constant upper abdominal pain that's achy and quality and then, you know, maybe they'll drink milk or toms or what have you , and , and that'll make it a little better. But then once your stomach's empty again, it'll come back. And over time that aching pain will progress and hopefully eventually , um, person will go and see somebody about it. Are

Speaker 3: 17:13

We all susceptible to this or who gets it? Um , you mentioned some, some underlying factors that might lead to

Speaker 4: 17:19

It. So there are things that can make you more at risk for getting it. Most notably there are medications that you may be taking for other things. Uh, the most noteworthy of those are, are drugs from a class called nonsteroidal anti-inflammatory drugs. And that's a long-winded way of talking about things like aspirin and Motrin and ibuprofen, not Tylenol, but the other over-the-counter pain medications can put you at risk for this. There's also , uh, an infection with a a , a bacteria called helicobacter pylori or h pylori, which is a common cause of ulcer disease. It lives in the mucus lining , uh, of your stomach and breaks that mucus lining down , uh, but making you more susceptible to ulcers. There are certain conditions that can affect the blood flow to the stomach's lining that impair its ability to make mucus. Uh , the most common of those is smoking. The

Speaker 3: 18:12

Other one more reason not to smoke.

Speaker 4: 18:14

Yeah. Yeah. They're , they're seemingly endless. Um, the other environmental exposure that, that , uh, can impair the stomachs lining and making more susceptible to ulcers is alcohol. Uh , so people often ask about spicy foods if that's a cause of ulcers and it , and it's really not. It, it can cause you to feel your ulcers mm-hmm . <affirmative> if you have 'em . And, and so spicy foods may be bringing to your attention something that's already happening, but they're not the driving cause or the underlying cause of ulcer .

Speaker 3: 18:42

That's an interesting distinction. I do hear that all the time. Absolutely. People say, you know, it's when I eat things, but all these other things are equally important risk factors for ulcers. Yeah. Okay. So how do you diagnose it? How do you diagnose all these things? For

Speaker 4: 18:55

Some of them we can, we can make a diagnosis based on a careful history talking to people and maybe even a trial of a medication to see if they respond to it. Sometimes that's sufficient to say, yep , this is what's going on and, and here's how we're gonna fix it. However, in a lot of , uh, circumstances it is, IM important to actually look in the stomach and swallowing tube to see what's going on. In the same way that it's important for your cardiologist to pull their stethoscope out and listen to your heart. As a gastroenterologist, a lot of my physical exam, a lot of what I do to examine a person is actually looking in their intestinal tract at the organ that we're worried about. And so endoscopy with a flexible scope is, is how a lot of these things are diagnosed. A lot

Speaker 3: 19:38

Of people know about the colonoscopy, and if you don't, I will refer you back to the podcast episode earlier this season with Dr. Matlock. But what does endoscopy look like for these conditions for ulcers and reflux?

Speaker 4: 19:51

So endoscopy refers to using a flexible tube with a light and a camera at the end of it to go through your mouth into your swallowing tube, stomach and small intestine to look around. The tube that we use is about the size of your pinky. So it's smaller than most food that you would swallow. It's got, as I said, has a light in a camera on one end and a steering wheel on the other. To do this , uh, we do typically sedate people. I've known people who've done it without sedation. It's uncommon and I wouldn't , it

Speaker 3: 20:22

Sounds uncomfortable, Jake. Good

Speaker 4: 20:23

Grief. Yeah. I wouldn't recommend it, but it has been done. But for most of us , uh, to get an endoscopy, we get some medications through an IV that will sedate us, make us very sleepy , uh, so that we're unaware or unconcerned about anything that's going on. And then the tube goes through our mouth and down into the stomach I can steer the tube through the entire swallowing tube stomach and first part of the small intestine and look at the lining of that entire structure. With that, we can tell if you have inflammation, damage from your reflux. We can tell if you have ulcers equally. And maybe even more important, we can see if you have any evidence of precancerous changes or even an actual tumor or cancer. So ,

Speaker 3: 21:06

So it looks differently. You are looking on a screen and, and it looks differently. Pre-cancerous changes or esophageal inflammation, the , the effects of reflux. You can see that

Speaker 4: 21:17

Absolutely. And, and, and again, for many people who have reflux, the effects are nothing. The , their exam will be normal . And that's sometimes a little disappointing for people 'cause they're, they're highly symptomatic. They've , they're feeling a lot of pain and you got

Speaker 3: 21:31

Nothing on

Speaker 4: 21:31

Exam. And I tell 'em, everything looks normal. That's actually good news and actually a pretty normal finding as you know , as we were talking about before, we all have an imperfect valve to some degree or another. And when I tell people that their exam is normal, that doesn't mean they're not having reflux. It means they're not suffering damage from it and they're not at risk for future health problems from, it doesn't make it any less miserable, but it means that there's not an additional thing to worry about in terms of a future consequence.

Speaker 3: 21:57

What does an ulcer look like? So

Speaker 4: 22:00

When I described it earlier as a divot, part of the reason that I said that is 'cause that's literally what it looks like. If you think of a , a tub of ice cream that you've taken one spoonful out of and you've got a , you know, a little dent in the top of that tub of ice cream, that's kind of what an ulcer looks like. Now at the base of that dent, it's gonna look red and inflamed and the edges are gonna be kind of heaped up and, and angry looking . It's, it's not subtle. It's easy to recognize and, and , uh, you

Speaker 3: 22:27

Probably think it looks cool. I've often teased Jake about what he does for a living. He puts tubes in and looks inside your intestines. And, and, and let's be honest, to the average listener, it sounds a little bit, there's a little bit of an eew factor . So if you do find things on these , uh, endoscopy exams, there are treatments available and people can , uh, do well, right?

Speaker 4: 22:48

Yeah. The overwhelming majority of findings , uh, on an endoscopy are things that we can respond to with alterations in a person's medical regimen. Often on a temporary basis, not a forever basis , uh, to get those things to resolve or heal. There is typically , uh, uh, also things that we can do to try to help people to prevent them from coming back. Uh , 'cause that's, that's another important factor. We don't want you to be back in the same circumstance a year down the road.

Speaker 3: 23:15

So many people have these things that we've been talking about both reflux and ulcers. And I really appreciate you giving us some tips on these topics. Before I let you go, Jake, what tips would you leave our listeners about upper GI health?

Speaker 4: 23:29

So the most important thing I think that all of us should think about in terms of our upper gastrointestinal tract health is eating food, not chemicals. Uh, you , you know, we, you and I were joking earlier about gas station sushi and I , I'm guilty as charged. I pick it up sometimes too , no question about it. But by and large, if you're eating food that starts out as a whole food, like a plant, and you're preparing it yourself, turning it into a meal, you're gonna be better served. That's gonna give you more of a plant-based diet. It's gonna give you more fiber, which is, is good for your entire digestive tract as well as the rest of your body. Uh, it's gonna limit your exposure to added sugars and other chemicals and preservatives which have deleterious effects on your health all around. So that's, that's the biggest thing. Eat food, mostly plants.

Speaker 3: 24:15

It's so interesting you say that because I have a lot of specialists on this show. It's a theme that kind of comes up. You didn't say come to see me so I can put a scope down your throat as the first thing. Um, you talked about what, what can lead to these? And then your biggest tip is to put healthy whole foods in your body, I find to be fascinating and frankly spot on . So I I really appreciate that. All right . What else should we keep in mind?

Speaker 4: 24:40

Well, you know, keeping your digestive tract moving in a , a forward , uh, manner is important. And the best way to do that is to keep your body moving. Uh , and getting up, moving around is, is healthy. Not again, not only for the rest of your body, but for your digestive function.

Speaker 3: 24:55

How about any other things people can do in their lives, maybe non-medical treatments , uh, to prevent reflux or the things we've talked about?

Speaker 4: 25:03

Sure. So particularly with regards to reflux, as we were talking about earlier, the thing that drives reflux is the movement of gastric contents or stomach contents up into the swallowing tube. And whereas we don't have an easy way to fix the valve, we can take advantage of gravity. And so things like making sure that you're sitting upright when you eat, not lying down shortly after eating. For some people, even raising the head of their bed , uh, to a 20 to 30 degree angle to try to use gravity to keep things down in the stomach can be helpful. Uh, those are rarely home run therapies that are really the things that, that, that will completely solve a problem. But they can help to some degree.

Speaker 3: 25:41

I knew a guy who had a wedge put into under the sheet of his bed, so it was, the thing was elevated 'cause he had bad refluxes. There's actually products people can buy, but you don't even have to do that. Right. Can't you just put a big book under the headboard or

Speaker 4: 25:53

Something? Yeah. I mean, I think the important thing to understand there is, is that you wanna make sure that you're not , uh, uh, crunching your abdomen. And so it's probably not good to be sleeping on two or three pillows if that's the problem you're trying to solve. 'cause that's just gonna kind of compress your abdominal cavity and, and change the pressure in such a way that you might be making things worse. Yeah . You

Speaker 3: 26:12

Don't wanna bend at the waist sort of while you're sleeping.

Speaker 4: 26:15

Right. So putting a , we used to say phone books. I don't think they make those anymore .

Speaker 3: 26:18

I know the big old Minneapolis phone book. I remember those. But

Speaker 4: 26:21

A , a brick under the, the headboard of your bed to, to, you know , raise the whole bed or put the whole bed at an angle is, is really more of what you're going for. We've

Speaker 3: 26:29

Been talking with Dr. Jake Matlock about reflux disease ulcers and all things about your upper intestinal tract . Jake, thanks for being on the show today. It's been a great show. Yeah, it's

Speaker 4: 26:38

Been fun. Thanks.

Speaker 3: 26:39

Glad to have you on. If you missed Dr. Matlock's previous episode with us, go to the archives. He talks about your lower intestinal trek . In other words, your colon. You're not gonna wanna miss that episode. Thank you for joining us for this episode, and I hope you'll tune in next time. In the meantime, be healthy and be well.

Speaker 2: 26:57

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. You got a question or a comment for the show? Email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. And finally, if you enjoy the show, please leave us a review and share the show with others. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive Producers are Jonathan, CTO and Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well .